Active NPI
Jennifer Wismer
- Dentist
- Brooklyn, NY
National Provider Identifier
1629531710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 061395-01
- Practice address
- 142 Joralemon St Ste 12C
Brooklyn, NY 11201-4709 - Phone
- (718) 625-2116
- NPI assigned
- Apr 7, 2019
- Last updated
- Sep 2, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 061395-01 | NY | Primary |
Addresses
Primary practice location
142 Joralemon St Ste 12C
Brooklyn, NY 11201-4709
Mailing address
474 Henry St Apt 4
Brooklyn, NY 11231-3027
Phone (646) 912-5724
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 061395-01 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630540800000",
"number": "1629531710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "474 HENRY ST APT 4",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112313027",
"telephone_number": "646-912-5724"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "142 JORALEMON ST STE 12C",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112014709",
"telephone_number": "718-625-2116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISMER",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-07",
"last_updated": "2021-09-02",
"certification_date": "2021-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "061395-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.